Provider Demographics
NPI:1467538371
Name:USCG HEADQUARTERS SUPPORT COMMAND (K)
Entity Type:Organization
Organization Name:USCG HEADQUARTERS SUPPORT COMMAND (K)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JILLYNDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-372-4103
Mailing Address - Street 1:COMDT 2100 2ND ST SW
Mailing Address - Street 2:CG-1122, SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:202-372-4103
Mailing Address - Fax:202-372-4912
Practice Address - Street 1:COMDT 2100 2ND ST SW
Practice Address - Street 2:CG-1122, SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:202-372-4103
Practice Address - Fax:202-372-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient